Drug Prices

Drug Importation Under Biden? | PharmacyChecker Blog

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Drug importation, by which I mean the process of buying much less expensive and equally safe prescription drugs from other countries, may see more sunlight under the Biden administration. For many drugs, the prices are frequently 90% less in other countries. Biden included drug importation among several policies he plans to pursue to lower drug prices. There’s momentum on drug importation from the Trump administration in the form of:

  1. An executive order calling for drug importation
  2. A final rule by the U.S. Food and Drug Administration to allow wholesale importation from Canada
  3. A request for proposal for personal drug importation programs
  4. a request for proposals relating to the importation of Insulin

The question remains if Biden will prioritize these initiatives. The political and policy climates are favorable for him to do so. Importation is broadly popular among Republicans and Democratic voters. Lowering drug prices is a central health care concern in America. Drug importation has incredible potential as an effective policy to end the price discrepancies Americans face with other citizens in other high-income countries.

Veterans of this issue like me are sensitive to the history here from the Obama-Biden years. Obama famously made a deal with Big Pharma in which his administration backtracked on plans to reform drug importation laws and allow Medicare to negotiate with drug companies to lower drug prices. In exchange, Big Pharma supported Obamacare and helped secure its passage. Caving to Big Pharma is politically deadly and the Democrats will have less appetite to do so now than they did in 2009.

Finally, Biden’s call for unity, which I strongly support and admire, is at play here. Almost all voters want to see action on drug prices generally, and that includes importation. In drug importation, Biden finds a cause for all Americans to get behind.

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Twitter’s Trump Ban and Big Pharma’s Online Censorship

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For someone who believes that Donald Trump’s actions, especially recent ones, have threatened the core of our democracy, it’s difficult to admit that the Twitter ban against him strikes a nerve with me. Getting right to the point: in the summer of 2018, Instagram shut down PharmacyChecker’s account. PharmacyChecker, which I co-founded in 2002, is a small, independently-funded online pharmacy verification and drug price comparison website. One of its claims to fame is providing information for consumers that can help them safely obtain lower-cost prescription drugs from other countries. PharmacyChecker helps people avoid rogue pharmacy websites and save money. So why did Instagram shut it down?

Germane to the matter is the fact that under most circumstances federal law prohibits the importation of prescription drugs for personal use. However, federal law makes many allowances to permit it anyway, despite the prohibitions. Tens of millions of Americans have imported medicines for personal use and none have been prosecuted for doing so. PharmacyChecker does not import, sell, distribute, process orders for medication in any way. It provides information. That information may be controversial but it’s not illegal. Nonetheless, it poses a threat to the pharmaceutical industry, which needs Americans to pay the highest prices on drugs to maintain their incredible profit margins. You see where this goes.

As I wrote two years ago about this…

“The pharmaceutical industry, generally, does not like our company [PharmacyChecker]. As an extension of that feeling, the FDA doesn’t love us either. Basically, we are in Big Pharma’s crosshairs because the information we provide helps people find more affordable medicines from other countries and import them for personal use.

But is that a reason for Instagram to shut down our account!? That action is nothing less than corporate-inspired, government-encouraged censorship.”

Consequently, PharmacyChecker later filed a lawsuit against several organizations and companies funded by or allied with large pharmaceutical companies through trade associations or non-profit organizations. It alleges that such groups have illegally colluded to suppress PharmacyChecker’s information by corralling large Internet companies to do their bidding.

As I write this, if you go to the search engine Bing and search for PharmacyChecker, you’ll find a pop-up warning next to organic search results, which blocks the link to PharmacyChecker.com. Why? PharmacyChecker is on a list of “Not Recommended Sites” published by the National Association of Boards of Pharmacy through a program it runs that was funded with a grant from Pfizer.

These pharmaceutical industry actions are extralegal against PharmacyChecker and flout norms of due process. This is a similar argument that Trump is making against Twitter.

Twitter’s position is that the information published by Trump violates its Glorification of Violence Policy. Twitter states: “We have permanently suspended the account due to the risk of further incitement of violence.” I’m sympathetic to that position. However, Twitter is a private company, which has the power to substantially curtail the ability of the U.S. president to communicate, and that scares me. Let’s flip this…

In 2018, Twitter suspended the accounts of 80 left-leaning activists from the Occupy Movement with a social network of 5 million people, according to Wired Magazine. Twitter did not give a reason.

Instagram has the ability to shut down accounts of businesses and people without giving them a reason or with any viable due process opportunity. Bing can post warnings against websites because its commercial interests may be intertwined with doing so, even if it’s wrong. Google can delist websites from its search engine with no accountability. Etc. Don’t even get me started on Facebook (which of course owns Instagram).

I’m not saying we should allow any content on the Internet. Not at all. Child porn; terrorist networks; and drug dealer websites are all quintessential examples. Should Twitter allow the leader of a country to lie to tens of millions of people in a manner that leads them to anger and violence?  I don’t think so. But there needs to be standards and accountability; without them, such actions to protect our democracy will surely undermine it.

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Drug Prices Are Up Again in 2021 and Canada’s PMPRB is On My Mind

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This week the prices of over 500 drugs went up in America, according to drug price transparency non-profit organization 46Brooklyn. This happens every year, usually coinciding with shouts of anger and disgust with the pharmaceutical industry’s greed. The shouts are muted this year, probably because, like it or not, we’re counting on Big Pharma to manufacture enough Covid-19 vaccines to end the pandemic. But the battle against high drug prices continues. Godspeed.

The median price increase reported was 4.6%, slightly lower than last year’s increase but about eight times the estimated inflation rate for 2020 of 0.62%. If you’re thinking I’m going to start talking about importing drugs from Canada now, you’re wrong – as helpful as that remains for Americans who go that route individually. [There’s an importation surprise at the end of this post for you, however.]

I’m thinking about the public health prism through which Canada views drug prices. I like the sound of that. Public health prism. What the hell does that mean? Well, I was perusing the updated guidelines on drug prices published by Canada’s Patented Medicine Prices Review Board (PMPRB) and one sentence stood out:

“The PMPRB’s existence as the only sector-specific price ceiling regulator under the Act reflects a recognition by policy makers that the unfettered ability to set prices for patented medicines is not in the public interest given the unique harm that can ensue if consumers are made to pay excessive prices for them.” 

The public health prism through which Canada views drug prices is one where “the unfettered ability to set prices for patented medicines is not in the public interest.” The PMPRB is a quasi-governmental entity tasked with preventing excessive drug prices in Canada. Its creation was mandated under Canada’s Patent Act, as amended in 1987, and it is independent of Health Canada. Notice the phrase “set prices”. Whatever drug price increases happen in the U.S. – and they are slower than last year – drug companies set prices way higher in the U.S. than in Canada. The harm to Americans is unique in that due to these high set prices, we forego filling prescriptions at rates far higher than in any other high-income country.

It may surprise you that Canada’s drug prices are higher than in most other countries. They are done with that. One of the main mechanisms for preventing excessive drug prices in Canada is to set prices based on the average prices among a basket of other high-income countries, referred to as international reference prices. Last year, the PMPRB dropped the U.S. and Switzerland from the basket of countries, the only countries with higher drug prices on average than Canada, and added countries with lower prices: Australia, Belgium, Japan, the Netherlands, Norway, and Spain. The PMPRB11 basket of countries now includes Australia, Belgium, France, Germany, Italy, Japan, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

The idea for creating a drug price review board in the United States is not new. In 1993, former Congressman Pete Stark (D-CA) introduced the aptly called Prescription Drug Prices Review Board Act of 1993.Apparently, the Clinton administration was supportive of the idea at the time, but according to the New York Times form 1993, “under heavy lobbying by the drug industry, the Administration has apparently backed away from the idea…”

Flash forward 23 years: Congresswoman Rosa DeLauro (D-CT) introduced the Prescription Drug and Medical Device Price Review Board Act of 2016 (H.R. 6501). The bill would establish the U.S. version of the Canada’s PMPRB. Its summary states:

“The board must establish a formula for determining whether the average manufacturer price of a prescription drug or medical device over an annual quarter is an excessive price.”

The bill has a special treat for Americans who believe they simply should not pay higher prices for drugs than in other countries. The bill states that the board “shall promulgate regulations permitting individuals to safely import from an approved country into the United States prescription drugs, and devices, that are comparable to prescription drugs, and devices, for which the Board makes a final determination that the manufacturer is charging or has charged an excessive price in violation of section 5(a) of the Prescription Drug and Medical Device Price Review Board Act of 2016.”

Could we get this type of legislation across the finish line?

Yes, Georgia’s on my mind, too…

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Good Judgement; Bad Judgment on Personal Drug Imports

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Here’s a kind of funny story to end the year with. I make a big deal on these pages about the decriminalized reality of personal drug importation. Federal law prohibits under most circumstances importing prescription drugs for your own use, but people are never busted for it. I’ve been around this a long time and I mean never. But that’s for personal use only. Recently, 20 U.S. air marshals in Dallas, Texas were disciplined for “smuggling” Viagra into the United States. They bought it at lower prices outside the U.S., brought it back, and gave it to their colleagues or sold it for a “small profit,” as reported in Yahoo News. So, are they in any real trouble?

It appears the answer is not really—at least not yet. The names of the air marshals are not public because they have not been charged with a crime. Some were suspended for a few days. One resigned. No one was terminated. However, two may be terminated based on “evidence uncovered during the investigation.” I would guess that those two were dabbling in the resale of stronger pharmaceuticals.

The scandal is referred to as “Bonergate”. The main thrust of the news coverage is that many of the 3,000 air marshals tasked with protecting flights from terrorism in the wake of 9-11 have been outed for various misdeeds. I’m going to remain agnostic on that issue. One comment made by Bill Beller the air marshal chapter president for the Federal Law Enforcement Officers Association is worthy of note:

“We have pride in our positions, and some people — whatever they did — I believe it was an error or error in judgment…”

Maybe. In contrast, Americans are using good judgment when buying medications for their own use from other countries because they can’t afford it here, as long as they do so wisely from licensed sources and possess a prescription for those medications. Bonergate may be funny, but the laws that curtail safe personal drug importation are no joke. Especially not to the millions of Americans who have to skip medications each year due to domestic costs. Big Pharma, on the other hand, is laughing all the way to the bank.

Happy New Year.

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Wishing You More Affordable Medicine This Christmas

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With some stops and starts, this blog has become far more focused on policy, regulatory matters, law and politics — and less on everyday consumer issues relating to drug prices. With Christmas upon us, I want to extoll PharmacyChecker.com’s simple core mission: make it easier for Americans to pay for their prescription drugs. Ask PharmacyChecker, the consumer journalistic section of PharmacyChecker, has a great piece up today called The Gift of Low Drug Prices. It speaks volumes about that mission.

Merry Christmas, America. 

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PhRMA’s Lawsuit Against Section 804 Ignores Statute’s Permissive Position on Personal Importation

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In its lawsuit to stop wholesale drug importation programs that could help lower U.S. drug prices, the Pharmaceutical Researchers and Manufacturers of America (PhRMA) may be stepping on its toes in helping to allow more personal drug importation. Last month, along with co-plaintiffs Partnership for Safe Medicines (PSM) and Council for Affordable Health Coverage (“CAHC”), PhRMA sued the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) to invalidate the certification by the HHS Secretary Alex Azar that drug importation from Canada is safe and will achieve savings for the American consumer.

In late September, Secretary Azar, in a final rule, certified that importing drugs from Canada, subject to Section 804 of the Food, Drug and Cosmetic Act (Section 804), 21 U.S.C. 384, Part L, poses “no additional risk to the public’s health and safety” and will “result in a significant reduction in the cost of covered products to the American consumer.” Those were the two certifications needed to allow a new wholesale drug importation channel.

Section 804 clearly distinguishes between wholesale (“commercial”) importation (subsections b-h) and personal importation (subsection J). As explained below, the standard for allowing personal importation is different. While PhRMA does not want either wholesale or personal importation to lead to lower drug prices, certain legal arguments it employs in its lawsuit may help the cause of expanding personal drug importation. Namely, personal drug imports can be permitted if they don’t pose an “unreasonable risk” to the patient; not so for wholesale imports (drugs that are resold). PhRMA ignores this.

The final rule identifies in detail the parameters of authorized importation. In summary: wholesale imports of qualified drugs by non-federal entities, such as states and tribes, subject to meeting safety requirements found in Section 804, who have submitted proposals that meet the requirements, are now allowed.

In contrast, the rule stated that it was not implementing personal drug importation provisions of Section 804. The main reason for not doing so, according to the proposed rule, is safety threats from rogue online pharmacies. While evidence shows that prescription drugs ordered from safe international online pharmacies help Americans save money, rogue sites are a real threat. I wish the Secretary had made the distinction, but that’s beyond the scope of this post.

PhRMA argues that Section 804 does not allow the Secretary to permit wholesale importation but neglected to make the same assertion in relation to personal drug importation. The court filing reads:

Section 804(l)(1) precludes the Secretary from certifying only commercial importation, but not personal importation. By its terms, Section 804(l)(1) requires the Secretary to certify that ‘implementation of this section’ will satisfy the safety and cost criteria in subparagraphs (A) and (B). Secretary Azar did not certify “implementation of this section” but only commercial importation under subsections (b) through (h).”

To this point, Section 804 does not go into effect without the certifications on safety and savings for wholesale and personal importation. PhRMA’s point appears to be that even if wholesale importation did meet the safety threshold (which it argues it does not) required under Section 804, personal importation has to as well. And because it doesn’t, according to the PhRMA, none of Section 804 can effective. Here is where PhRMA fails to mention the different safety thresholds identified in Section 804 between wholesale and personal importation.

Unrelated to the wholesale drug importation provisions of Section 804, Part J states that personal importation, based on enforcement discretion, should be allowed as long as the import does not pose an “unreasonable risk” to the patient. In other words, it doesn’t make personal importation expressly legal like wholesale importation; it permits otherwise illegal importation for individuals.

I believe this part of the law has always been effective in terms of expressing the will of Congress even in the absence of the Secretary’s certification under Part L. However, now that the Part L certifications are satisfied, at least according to PhRMA, Part J, permitting otherwise illegal imports for personal use only, must be in effect.

When Congress passed this law, it recognized that Americans may not be able to afford prescription drugs domestically and should be able to buy them from another country. It set up a standard allowing consumers a fair degree of choice and told the FDA that the standard for its enforcement activity should be stopping an import that is an “unreasonable risk” to the individual. That risk is separate from risks to the “public’s health” from larger-scale, wholesale imports. If Congress wanted there to be “no additional risk” to individuals who import for their own use, then it could have said so.

The thing is that imports for personal use from licensed pharmacies in Canada and many other countries that require valid prescriptions are very safe, not to mention not an “unreasonable risk”. There’s a clear case to be made that Americans should feel emboldened to import prescription drugs for personal use now that Section 804 is in effect, at least according PhRMA!

For those who choose to import lower-cost prescription drugs, and order them online, make sure to stay safe by only ordering from credentialed international online pharmacies.

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Human Rights Day: Safe and Affordable Imported Medicine and the Internet

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Today is Human Rights Day, a day commemorating the United Nations’ 1948 adoption of the Universal Declaration of Human Rights (UDHR). Three years after World War II ended, in the wake of genocide, unprecedented military, deadly armed conflict, and mass deprivation on a global scale, the UN declared that all people in the world have rights that defend the dignity of humankind. Freedom of religion, speech, the right to assemble and own property, protection from discrimination or persecution are all central to human rights. Everyone has these rights “without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”

These rights are applicable to Americans who can’t afford prescription drugs domestically because the prices are too high. Human rights include access to safe and affordable medicines, such as through importation of a more affordable drug ordered over the Internet.

In 2017, a group of activists, policy professionals, lawyers, and doctors came together in Brussels at the RightsCon conference to draft the Brussels Principles on the Sale of Medicines Over the Internet. Those principles were refined at RightsCon Toronto in 2018. The aspirational document supports the idea that principles of human rights should definitely apply to how we address access to medicine. Key parts of the document that apply include:

Recognizing that “The Internet has served as a disruptive force to traditional industry in the practice of pharmacy and trade in pharmaceutical products, allowing for the international sale of medical products to patients with a prescription.”

Affirming that in relation to the sale of medical products ordered for personal use over the Internet, “Access to affordable medical products is a fundamental component of the right to health”

How can we tie this to the UDHR? It states in Article 25:

“(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”

Just three years ago, the UN Human Rights Council unequivocally declared that “Access to essential medicines is a fundamental element of the right to health”

Achieving universal access to essential medicines is also a part of the UN Sustainable Development Goals, SDG 3.8. Last year, I took the opportunity to respond to a request for public comments on this issue from the World Health Organization:

In support of SDG 3.8, the Internet, via international online pharmacies, has helped tens of millions of Americans obtain medicines from pharmacies in other countries.[v] In many of those cases, patients would otherwise not be able to obtain a prescribed medicine because price often determines access.[vi] In recognizing that price is an obstacle to access to medicines, Global Health Organizations can play a more constructive, forward-thinking role by promoting an open Internet through which regulated medicines can be purchased across borders both safely and at lower cost.

Let me put this into a concrete, real-world scenario. Let’s say a sick person in the U.S. can’t afford a prescription drug that they need to get better. They buy it online at a price they can afford, submitting a valid prescription from their doctor to a foreign licensed pharmacy, one that is lawfully permitted to ship it to that patient. It’s the exact same drug sold here. The prescription drug order import is refused and destroyed by the U.S. FDA because its label is not the one required for the sale of that drug in the U.S. The government has deprived that person of access to healthcare. Are their human rights being violated?  While most personal imports can be successfully received, the FDA does take away people’s prescription drugs as described.

See: FDA Destroys Elizabeth’s Personal Drug Import

As we honor human rights today and the Universal Declaration of Human Rights, our national and global health imperative is the distribution and administration of a vaccine to protect us all from Covid-19.

I’m dedicated to a future where we win the fight to make sure all people have the right to obtain the medicine they need to protect their health and save lives.  

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Canada’s Order Against U.S. Drug Imports to Prevent Shortages Directed at Wholesale Not Patient Purchases

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Canada issued an interim order on Friday, November 27, preventing drug establishments from exporting products that would risk causing domestic shortages. The press release with quotes from Health Minister Patty Hajdu may be more digestible than the official order.

As I see it, Americans who rely on buying less expensive prescription drugs from Canada should not be too concerned about this new development. The order is directed at companies who distribute drugs via wholesale channels, not pharmacies that dispense drugs directly to patients. Patients in the U.S. with a valid prescription who safely order drugs from pharmacies in Canada do so through licensed retail pharmacies not wholesalers.

The order was issued prior to the final rule in the U.S. allowing wholesale importation of lower cost drugs from Canada under what’s known as Section 804, which became effective November 30. States and other non-federal entities will need approval from the Secretary of Health and Human Services in order for any wholesale drug importation to commence under the new rule. Over the last year or so, Canada has expressed concerns about the Trump administration’s policies, fearing that larger scale wholesale drug importation from the U.S. could cause shortages. Canadian officials site the fact that the U.S. population is far larger. The U.S. has 329 million compared to Canada’s 38 million people. In any case, nothing has changed as of yet because Section 804 imports have not begun.

Drug shortages are a problem in many countries, Canada and the U.S. included. For information about drug shortages in the U.S. see: https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages; in Canada, see: https://www.drugshortagescanada.ca/.

The order states that a drug establishment may only distribute drugs for consumption outside of Canada if it “has reasonable grounds to believe that the distribution will not cause or exacerbate a shortage of the drug.” It also mandates new reporting requirements for those establishments that export drugs.

Canada has the right and obligation to protect its citizens from drug shortages. Its actions are understandable, if not commendable. However, Canada’s efforts do not mean that new initiatives on drug importation to lower prices in the U.S. will fail. It means that when wholesale importation commences through the new Section 804 channels, they must not cause shortages in Canada. It’s unknown at this time which specific products might be affected and the new order by Canada doesn’t mention any.

Licensed pharmacies in Canada that dispense prescription drugs to patients in the U.S. play an important role in helping Americans access treatments that are otherwise unaffordable. For the individual patients, that access is incredibly helpful, if not lifesaving. In the grand scheme of things, the personal drug importation market is too small to cause shortages in Canada. Furthermore, many “Canadian” online pharmacies partner with licensed pharmacies in other countries to fill prescription orders for Americans.

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Millions of Americans Who Struggle with Drug Costs Are Also Hungry: Help Them This Thanksgiving

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In Thanksgiving seasons past, I have written posts connecting the problems of high drug prices and hunger in America. Where people and households are struggling to afford food, there’s a greater likelihood that they are forgoing needed medical treatments, including prescription drugs. The problem is far worse for people with chronic medical conditions. This may seem intuitive and obvious, but for those wanting some academic research to chew on, take a look at this from The American Journal of Medicine:

Treat or Eat: Food Insecurity, Cost-related Medication Underuse, and Unmet Needs.”

The research concludes: “Approximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both.” NHIS refers to the National Health Interview Survey.

Everything is worse this year. If you can help others who need it then you should.

Last year, a survey by Kaiser Family Foundation showed that about 25% of Americans say it’s difficult to afford their prescription drugs. That was before the pandemic. This Thanksgiving, in a disastrous second wave, America is witnessing the longest lines for food banks since the Great Depression. Reporting by National Geographic shows that 1 in 6 Americans could go hungry.  

Instead of pontificating with digs at Big Pharma or pointing to more depressing data, I’m going to ask that you Donate to Hunger Free America.

Hunger Free America “is a nonpartisan, national nonprofit organization building the movement to enact the policies and programs needed to end domestic hunger and ensure that all Americans have sufficient access to nutritious food.”

To you and yours, a Happy Thanksgiving

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Amazon’s Pharmacy Doesn’t Break Big Pharma’s Hold of America’s Neck

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Forgetting about the potential dangers to competition from corporate Leviathan Amazon, that it launched a new online pharmacy this week will certainly appeal to tens of millions of Americans. Prescription drugs are yet another thing you can get when you go to Amazon.com. And if you’re an Amazon Prime member (aren’t we all?), then there are discounts and whip-fast delivery to be had. But, unlike in many other industries where Amazon can crush the competition on prices, its online pharmacy launch does not accomplish that. Brand name drugs, ones without and even with generic competition, are similarly priced to other American pharmacies. PharmacyChecker checked this out and has some good advice for consumers about Amazon’s pharmacy at Ask PharmacyChecker this week.

Overall, brand name drugs do not appear to be any cheaper using Amazon Pharmacy than what you can get using a discount card found on GoodRx or PharmacyChecker. How can they when the pharmaceutical industry has monopolistic pricing power over patented drugs? Amazon is subject to the same average wholesale acquisition costs as Walgreens. Not only do drug manufacturers have patents: they have special international trade protections where companies cannot import these same drugs from foreign wholesalers who charge much lower prices in Canada, not to mention the even lower prices in the UK and European Union countries – unless the drug manufacturers do the importing or authorize it. 

Quick case in point. Insulin access activist Laura Marston, who has type 1 diabetes and needs insulin to live, tweeted that for insulin lispro, an authorized generic Amazon charges $137 a vial, only $4 savings. Why would I bring up a generic drug when my point above was about brand drugs? A vial of brand Humalog runs about $30 in Canada. That’s why people travel to and buy prescription drugs online from Canada and other countries. 

Now I’ve thought about Jeff Bezos and Amazon for a long time when it comes to this issue. I’ve also thought a lot about Senator Bernie Sanders’s outspoken stances against Big Pharma and Amazon. It led me to write an article last year that posed the question of what would happen if Bezos and Sanders teamed up to bring about comprehensive drug importation reform, opening up the U.S. market to lower drug price. Not surprisingly, the article is called “Jeff Bezos should team up with Bernie Sanders to offer lower drug prices to Americans.” 

Let me pivot to Walgreens for a minute. The full name of Walgreens is actually Walgreens Boots Alliance. Walgreens was founded in the U.S.; Boots in the UK. It is now a multinational pharmacy retailer and wholesaler, operating various businesses in 25 countries and with stores in 11 countries, according to its website. They sell the exact same prescription drugs at a Boots UK pharmacy for a fraction of the cost you’d find at your local Walgreens on main street, USA! Not cool. Not fair. See: The Walgreens UK Pharmacy Connection and Importation

For about 20 years now, Senator Sanders, first in the House, and then in the Senate, has been calling for safe drug importation, understanding that ending the prohibitions on drug importation that do not actually protect safety (just Pharma profits) will infuse competition to lower prices here. Jeff Bezos is the ultimate back breaker of traditional, entrenched and protected interests. He should relish the opportunity to do this. Amazon has the money and lobbying power to make it work! 

Our country is horribly divided right now. A Bezos-Bernie effort on drug prices could bring us together and finally break Big Pharma’s hold on our captive pharmaceutical marketplace. As it stands now, Amazon Pharmacy has not done so.

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